Ch 21 prep U

A client comes to the clinic for a follow-up visit. The nurse notes a sunburn-like appearance to the client's skin. The client's history reveals the use of ciprofloxacin. The nurse interprets which adverse effect regarding this finding?

photosensitivity

What response should the nurse provide to explain to a parent why chloramphenicol was likely not the drug of choice for the treatment of their child diagnosed with meningococcal meningitis?

"Chloramphenicol isn't used unless there is no adequate substitute drug available."

The nurse is giving instructions to the client prior to discharge. The client states that he does not like to take a lot of drugs. The nurse's best response would be what?

"Failure to complete the entire treatment may result in a return of the infection."

After teaching a client who is prescribed oral erythromycin, the nurse determines that the teaching was successful when the client states which of the following?

"I should drink a full 8-oz glass of water when I take the medicine."

A client has been prescribed daptomycin for treatment of an infection. What instruction is most important for the nurse to tell this client?

"Tell the health care provider immediately if you develop any muscle pain."

What information will the nurse teach the client being switched to azithromycin from erythromycin?

"This drug has enhanced antibacterial activity."

Which of the following would a nurse identify as being classified as a macrolide?

Azithromycin

A client is diagnosed with VRE, and the health care provider orders chloramphenicol. The nurse should monitor the client for the development of which side effect?

Blood dyscrasias

A client has an upper respiratory infection and is allergic to penicillin. What medication does the nurse expect will be ordered?

Erythromycin. A macrolide can be given safely to a client who is allergic to penicillin. Ampicillin, Ancef, and cephalosporins cannot be given because of the risk of cross-sensitivity.

Rifaximin (Xifaxan) is effective to treat traveler's diarrhea from which of the following organisms?

Escherichia coli. It cannot be used to treat C. jejuni. Effectiveness against Shigella and Salmonella is unknown.

A common reaction associated with the intravenous administration of vancomycin is "red man syndrome." What is the cause of red man syndrome?

Histamine release.

Which statement is true concerning macrolides?

Macrolides are bacteriocidal or bacteriostatic.

John, 34 years old, is being treated with clindamycin for osteomyelitis of his tibia following an open fracture 3 months ago. The nurse is teaching John how to properly administer the medication at home and the side effects that he needs to report to the health care provider. Which would be the best instruction to give John?

Notify the provider if you have any blood in your stool or diarrhea. The most serious adverse effect is pseudomembranous colitis (a Black Box warning), also known as Clostridium difficile colitis.

What is the most common adverse reaction to IV vancomycin?

Red man syndrome

Bacterias have readily evolved. Which type of bacteria are most commonly resistant to vancomycin?

Enterococci

Your patient is receiving a macrolide, ketolide, or miscellaneous antibacterial to treat an infection. Which of the following evaluations would be appropriate to include in your plan of care? Select all that apply.

Interview and observe for improvement in the infection being treated. Interview and observe for adverse drug effects.

A nurse is caring for a client with severe and life-threatening pseudomembranous colitis caused by C. difficile. Which drug would the nurse expect the client's provider to order?

Oral vancomycin. Oral vancomycin is used to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile when the colitis fails to respond to metronidazole.

A health care provider is deciding what medication to prescribe for a client with an upper respiratory infection. What principles guide the provider's decision? Select all that apply.

Resistance of the bacteria Other drugs the client is taking daily The client's ability to tolerate the drug

Your patient is receiving a miscellaneous anitbacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply.

The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. The patient will be monitored regularly for therapeutic and adverse drug effects. The patient will verbalize and practice measures to prevent recurrent infection

A client prescribed rifaximin for diarrhea has developed frank bleeding in the stool. What intervention should the nurse anticipate being implemented to best ensure client safety?

changing to a different antibiotic. Because of its very limited systemic absorption (97% eliminated in feces), health care providers cannot use rifaximin to treat systemic infections, including infections due to invasive strains of E. coli. Therefore, diarrhea occurring with fever or bloody stools requires treatment with alternative agents.

A client returns from a vacation with traveler's diarrhea. The nurse understands that what is the treatment of choice?

Rifaximin

A client received erythromycin before dental surgery. The client has a past history of a cardiac surgery. The rest of the client's history is unremarkable. What does the nurse teach the client about this medication?

"You are receiving this medication to prevent infection that may affect your heart." The client with a prior history of a heart defect is at risk for bacteria growing in the area of the defect. The client should receive prophylactic antibiotics with any surgery or invasive procedure.

A male client presents to the emergency department with an abdominal dehiscence. He states he had a hernia repair 18 days earlier, and the health care provider removed his wound staples 5 days ago. The client states that the dehiscence occurred when he lifted a box this morning for his wife. The wound is red, and there is evidence of foul-smelling drainage. The wound is cultured, and an anaerobic bacterium is identified. The nurse understands that the provider orders metronidazole because it is effective against which type of organism?

Anaerobic bacteria.Metronidazole is effective against infections with anaerobic bacteria and some protozoa.

The nursing instructor is discussing the administration of azithromycin, a macrolide, with her clinical group. The instructor asks her students to identify the medication that will decrease the effects of azithromycin when administered concurrently. Which of the following medications would the students identify?

Antacids

A patient has been administered linezolid. The patient is fond of eating chocolates and coffee, both of which contain tyramine. What should the nurse inform the patient about the risk involved when linezolid interacts with foods containing tyramine?

Causes severe hypertension.

Linezolid (Zyvox) can be used to treat which of the following infections? Select all that apply.

Community-acquired pneumonia (CAP) Vancomycin-resistant Enterococcus faecium (VREF) Methicillin-resistant Staphylococcus aureus (MRSA) Nosocomial pneumonia

You are caring for a 60-year-old female patient who is expected to undergo extended treatment with linezolid. What lab value may require close monitoring during drug therapy?

Complete blood count

A nurse is caring for a 25-year-old patient who has been prescribed daptomycin to treat a skin infection. Which of the following adverse effects of daptomycin should the nurse monitor when caring for the patient?

Constipation

A nurse is required to administer an anti-infective drug to a patient. The nurse knows that which of the following tests need to be conducted before administering the first dose of an anti-infective drug to the patient?

Culture tests

What is an advantage of daptomycin over other antibiotic therapy?

Daptomycin has less antibiotic resistance than other drugs used to treat against Gram-positive bacteria.

A client is taking clindamycin for an infectious process and presents to the health care provider's office with symptoms of dehydration. The nurse understands that the client is experiencing what adverse reaction from the administration of clindamycin?

Diarrhea

A client is diagnosed with an infectious process that is sensitive to penicillin. The client is allergic to penicillin, so the health care provider orders a drug with a similar antibacterial spectrum. The nurse anticipates that the provider will order what antibiotic?

Erythromycin. Erythromycin shares a similar antibacterial spectrum with penicillin, making it a good choice for clients with penicillin allergy.

A patient with acne vulgaris was administered macrolides, after which the patient developed diarrhea. What nursing intervention should the nurse perform in this case?

Inspect stools for blood or mucus.

A female client's medical history includes type 2 diabetes, CVA, dysphasia, and chronic renal failure. She develops an infectious process. The health care provider orders erythromycin. Based on the client's medical history, why is erythromycin the drug of choice?

It is metabolized in the liver.

A client with-end stage renal disease has developed vancoymcin-resistant enterococci (VRE). Which medications could be used to treat this client? Select all that apply.

Linezolid (Zyvox), an oxazolidinone Chloramphenicol (Chloromycetin), an amphenicol Daptomycin (Cubicin), a cyclic lipopeptide

In which condition present in the client should macrolides be used with caution?

Liver dysfunction. All macrolides should be used with caution in clients with liver dysfunction. Pre-existing liver disease is a contraindication.Diabetes, hypertension and glaucoma are not contraindicated.

A client presents to the health care provider's office with a skin infection on the forearm. The infection is resistant to over-the-counter antibiotics. After receiving the culture and sensitivity results, the provider orders tigecycline. The nurse knows that this client has what illness?

MRSA

The health care provider suspects a client may be infected with an antibiotic-resistant pathogen. The nurse caring for this client knows that what course of action is best used to determine whether this type of pathogen is present?

Perform culture and susceptibility tests.

The nurse is caring for a client who is receiving IV vancomycin. The nurse infuses the medication at the prescribed rate to prevent what from occurring?

Red man syndrome. With this syndrome, the client's face and upper trunk becomes bright red, and it has led to cardiovascular collapse.

A client who has been receiving intravenous (IV) vancomycin begins to report neck and back pain as well as feeling hot and having chills. The nurse assesses the client and notices that the neck is red. The client's temperature is 102 degrees F; BP is 86/58. This client is showing signs and symptoms of which syndrome?

Red-man syndrome

A client, being treated in the intensive care unit, has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the client's sputum indicates that erythromycin is a treatment option. Which nursing assessment is most appropriate to rule out contraindications for this medication therapy?

Review lab results to confirm normal liver function.

Common, potentially serious, adverse effects of antibiotic drugs include:

Skin rash. Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory status—including rate, depth, and adventitious sounds to provide a baseline for determining adverse reactions. Report nausea, vomiting, diarrhea, skin rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection.

Which client should not receive erythromycin as ordered at 8 a.m.?

The client with elevated liver enzymes. The medication is metabolized by the liver and excreted in the bile. The client with elevated liver enzymes will not be able to tolerate this medication. There is a risk it will build up in the system. The other situations are not contraindications for taking erythromycin.

The patient is receiving vancomycin (Vancocin) intravenously. The nurse assesses the patient and finds that the patient has flushed skin, a rash, and a drop in blood pressure. Which of the following actions probably has happened?

The IV infusion is too fast.

Which client should be assessed further before receiving azithromycin (Zithromax) as ordered?

The client who is taking digoxin

A patient on your unit has bacterial colitis and is being treated with oral vancomycin. Why is vancomycin given orally, rather than intravenously, in the treatment of bacterial colitis?

The oral version of the drug acts within the bowel lumen.

Your patient is receiving a miscellaneous anitbacterial to treat an infection. Which of the following goals would be appropriate to include in your plan of care? Select all that apply

The patient will take or receive miscellaneous antimicrobials accurately, for the prescribed length of time. The patient will be monitored regularly for therapeutic and adverse drug effects. The patient will verbalize and practice measures to prevent recurrent infection.

Rifaximin (Xifaxan) is a structural analog of rifampin. Which of the following describes rifaximin? Choose all that apply.

Used in infectious (traveler's) diarrhea from Escherichia coli 97% eliminated in feces Cannot be used to treat systemic infections

Which of the following are characteristics of clindamycin (Cleocin)? Choose all that apply.

Miscellaneous antibacterial Often used to treat infections caused by B. fragilis A topical solution used to treat acne

The nurse is caring for a patient who is being treated with the drug Linezolid. What foods should the nurse isntruct the patient to avoid while taking this drug? (check all that apply)

aged cheese chocolate iced tea yogurt

You are a pediatric nurse caring for a child receiving erythromycin ethylsuccinate. The recommended dose for this drug is 30 mg/kg/day. The child weighs 20 kg, and the medication is to be administered q8h. How much medication should this child receive per dose?

200 mg

A patient is required to be administered vancomycin for treatment of an abdominal abscess. What should the nurse ensure when monitoring the IV infusion of vancomycin in the patient when caring for him?

Administer each dose over 60 minutes.

A patient taking erythromycin (E-mycin) is having difficulty hearing the nurse. How should the nurse proceed?

Ask about the patient's hearing prior to medication therapy.

A client develops antibiotic-induced colitis. The symptoms have worsened within the past 72 hours. The nurse expects the health care provider to order what medication, which is considered the initial drug of choice?

Metronidazole. In antibiotic-associated colitis, stopping the causative drug is the initial treatment. If symptoms do not improve within 3 or 4 days, oral metronidazole or vancomycin is given for 7 to 10 days.

An 87-year-old resident of a long-term care facility has been prescribed oral clindamycin for the treatment of an infected pressure ulcer. The care providers at the facility should be instructed to monitor the resident closely for what potential adverse effect of clindamycin?

Diarrhea. The most serious adverse effect of clindamycin is pseudomembranous colitis, also known as Clostridium difficile colitis. Diarrhea, abdominal cramps, and abdominal tenderness may suggest antibiotic-associated colitis.

A 78-year-old female, who lives alone and is forgetful, is being seen by her home health nurse. In reviewing the patient's medication the nurse discovers that the patient is taking azithromycin (Zithromax) for urethritis. Why would this be a good choice of antibiotics for this patient?

It is taken only once a day.

A patient has been prescribed daptomycin for a complicated skin infection. Which of the following will the nurse advise the patient to report immediately?

Muscle pain or tingling. The nurse should teach the patient the importance of reporting diarrhea, muscle pain and tingling, and fatigue immediately because these signs and symptoms can indicate potentially severe adverse effects. Nausea and vomiting, palpitations, and abdominal pain are all adverse effects of ciprofloxacin.

The nurse should monitor the client for which common side effects of erythromycin therapy?

Nausea, vomiting, and diarrhea

What medication could be prescribed orally to treat a sinus infection in a client needing an abbreviated therapy plan?

azithromycin. For acute bacterial sinusitis, azithromycin is approved for an abbreviated 3-day treatment duration. None of the other options are approved for such treatment.

A client with an upper respiratory infection has been prescribed macrolides. Which changes during an ongoing assessment would lead the nurse to notify the health care provider? Select all that apply.

drop in blood pressure increase in respiratory rate sudden increase in temperature

Which of the following drugs are considered to be macrolides? Choose all that apply.

erythromycin azithromycin (Zithromax) clarithromycin (Biaxin)

A client reports having had a "bad reaction" the last time receiving penicillin. Prior to a scheduled dental procedure, the client is likely to be prescribed what drug?

erythromycin. Prophylactically, erythromycin is administered to prevent alpha-hemolytic streptococcal endocarditis before dental or other procedures in clients who have valvular heart disease and are allergic to penicillin.

What medication would the nurse anticipate being prescribed for a client diagnosed with trichomoniasis?

metronidazole. Metronidazole is effective against anaerobic bacteria, including gram-negative bacilli such as Bacteroides, gram-positive bacilli such as Clostridia, and some gram-positive cocci. It is also effective against protozoa that cause amebiasis, giardiasis, and trichomoniasis. None of the other options would effectively manage this infection.

The nurse realizes that vancomycin is a powerful drug and can treat serious gram-positive infections that do not respond to treatment with other anti-infectives. Serious adverse effects classic for vancomycin include which of the following? (Select all that apply.)

nephrotoxicity ototoxicity

A nurse is getting ready to begin intravenous (IV) vancomycin therapy for a client and must determine the rate of administration before hanging. The nurse proceeds to run it over 60 minutes. Doing so prevents what complication?

profound drop in blood pressure

A client developed a pressure area on the hip that has become infected. If the wound culture reveals methicillin-resistant Staphylococcus aureus, which medication would the nurse expect to be prescribed?

vancomycin. Vancomycin is active only against gram-positive microorganisms. It acts by inhibiting cell wall synthesis. Parenteral vancomycin has been used extensively to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant staphylococcal species non-aureus (SSNA, including Staphylococcus epidermidis), and endocarditis caused by Streptococcus viridans (in clients allergic to or with infections resistant to penicillins and cephalosporins) or E. faecalis (with an aminoglycoside).